Mental Functioning: Dr. Peter Rice

Mental Functioning Drugs

I’m back after a short break to finish up my semester teaching assignments and a couple of final exams. I’m always watching for interesting topics to write about, and coincidental with final exams, the topic of nootropic drugs – medicines that enhance brain, mental functioning – seemed to come up from several people.

It all started with an internet article that my son sent me on “Getting Ahead in Silicon Valley”, about the popularity of certain drugs to improve mental functioning. A software engineer, Daniel has an engineer’s viewpoint and often challenges me with new ideas with the general theme of optimizing system performance.

Mental Functioning

In the community pharmacy setting, we’re used to seeing drugs that are meant to improve mental functioning.

Children diagnosed with attention deficit hyperactivity disorder – ADHD – often receive amphetamine-related drugs such as methylphenidate (Ritalin™). These children grow up to become adults, often college students, who may continue to use these drugs to help them focus and function better with adult ADHD.

The amphetamines are prototypical nerve stimulants for mental functioning.

First marketed as a decongestant nasal inhalant, amphetamine is taken up by certain nerves in which it enhances release of the adrenergic neurotransmitters norepinephrine, epinephrine and dopamine.

It is believed to help in ADHD by stimulating the parts of the nervous system that encourage self-control and function.

And of course, amphetamines can contribute to physical and psychological dependence and in higher doses can produce toxicity and psychosis.

The nootropic drugs are different. The original “nootropic drug” was piracetam, first synthesized in 1964 and marketed in Europe as Nootropil™. Piracetam is not approved by the Food and Drug Administration, and cannot be marketed in the US as either a drug, vitamin, or dietary supplement. It’s mechanism of action is not entirely established, but is different from that of the amphetamines.And there are other classes of drugs that may improve mental function, including some drugs intended to treat Alzheimer’s disease, narcolepsy or seizures.

This being America, businesses have started to meet the needs of those seeking nootropics.But don’t go jumping on the nootropic bandwagon right yet.

Let’s consider our options:

First, studies of drugs which enhance cognitive performance are generally performed only on individuals who are not sleep-deprived.Getting a good night’s sleep is likely the very best thing you can do for your mental performance.

Second, if you examine the ingredients in commercial nootropic blends, you will meet some old friends.Caffeine is a frequent ingredient. So is L-theanine, a nondietary amino acid found in tea, which may be responsible for its relaxing effects. Perhaps you are one of those who consider yourself a “morning person”; I generally awaken early and feel I function well in the mornings.It could be the good night’s sleep or it could be my morning cup of tea. All nootropics of sorts.

Third, let’s remember the advice of Socrates – “all things in moderation”. You can expect that there is an optimal dose for these drugs. For example, one cup of coffee in the morning might help you wake up and think more clearly; four cups might have your mind working so rapidly that you cannot focus and function well.

And just as certain drugs may enhance mental functioning, there are drugs and drug classes that can decrease mental functioning.

Alcohol is certainly one, although there are those dangerous few who believe they think more clearly following a few drinks. Drugs which decrease the activity of the neurotransmitter acetylcholine are others; these have the opposite mechanism of those drugs which may help Alzheimer’s patients. And there are other drugs which your pharmacist should know about.

So, if you’re an engineer-type just seeking to enhance system performance, at least start with adequate sleep and some moderate coffee or tea.If you’re a patient or family member worried about a patient’s declining or limited mental functioning, have a good pharmacist perform a thorough medication review to see if there might be a prescription, nonprescription or dietary supplement drug that is either responsible for or not helping the situation.

We all want to operate at our best all the time. Good sleep and good nutrition can always help. Good drugs, or avoiding bad drugs, can sometimes help, too.Talk to your pharmacist or prescriber about how you can take better care of yourself.

About Dr. Peter J. Rice

Dr. Peter J. Rice is a professor of Pharmacology emeritus at the East Tennessee State University Quillen College of Medicine and Professor of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. --------------------------------------------------------------------------He received his BS in pharmacy from Northeastern University, PhD in pharmacology from the Ohio State University and PharmD from the University of Kentucky. He is a Board Certified Pharmacotherapy Specialist and practices in the ambulatory care and community pharmacy settings. Professor Rice is the author of Understanding Drug Action: An introduction to pharmacology (APhA, 2014) and is a fellow of the American Pharmacists Association. --------------------------He welcomes interesting medication questions and suggestions for future columns.

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